Spotlight: Five Decades of Self Care - PAGB's Self Care Journey

Published on: 6th November 2019

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Celebrating 100 years of consumer healthcare spotlight header image

For more than five decades PAGB has driven the self care message, seeking to create behaviour change among people and healthcare practitioners.  We have worked to create a self care focused environment and spearheaded the way with research, vision, collaborations, intervention and most of all, stubborn perseverance.  This is the story of PAGB’s self care journey.

Paul Bennett

Within a decade of the launch of the NHS in 1948, the issues we continue to grapple with today were first raised: how to help people take responsibility for their own health and wellbeing, particularly for common and self limiting conditions, rather than turning to an overburdened NHS?

Almost overnight, the introduction of the NHS removed the responsibility of the population to take care of its own health.  Generations who had managed their coughs, colds, sore throats, rashes, fevers and sprains were suddenly able to access free health advice from a qualified source. Unfortunately, this led to much of the population abdicating responsibility, becoming passive recipients of care, even for the simplest of health problems.

Three generations on, in 2019, this is still the case for too many people.

Looking back at our archives, as early as 1959, PAGB realised it was essential to drive self care, to effect cultural and behavioural change in the population.  PAGB’s Annual Report of 1959/60 succinctly highlights the simple message we still promote today:

Sensible self-medication for minor ailments with modern home remedies plays a beneficial and very necessary role in everyday life. It contributes directly to the general health of the nation; and indirectly, by relieving unnecessary pressure on the general practitioner and the resources of the National Health Service.”

Research 

To effect change, it is necessary to understand how people manage their health and what motivates their behaviour – why they take the actions that they do.  Therefore PAGB, at various stages over the years, has commissioned consumer research to understand how best to promote self care.

The first research PAGB undertook in this area was in the mid-1960s when it commissioned the National Opinion Polls to look at what type of ailments the UK population suffered from.  This research found that:

The 1970s saw several self care highlights for PAGB including the first Panel on Self Care in 1972 and the 1979 Royal Commission Report which recommended the use of self-medication.  However, PAGB’s self care work programme really accelerated in the 1980s. Director Sheila Kelly and Head of Public Affairs, Gopa Mitra both brought renewed vigour and extraordinary vision to the issue.  They began by commissioning ground-breaking research in 1986 in the form of the Everyday Healthcare Study, conducted by the British Market Research Bureau (BMRB). 

This was the first national survey of everyday healthcare in Britain. It was innovative in its scope with 1217 40-minute interviews in people’s homes gaining detailed insight into their self-medication behaviour. The survey revealed that people suffered an average of five ailments in any two weeks; that they were able to discriminate between those that were serious, and that the majority were managed without visiting a doctor.

This research enabled PAGB to paint a picture of how people managed their health, it helped to open doors and begin conversations with parliamentarians, medical Royal Colleges, the NHS and Government about the benefits of self care in the population.  It kickstarted a series of projects including the innovative OTC Directory in 1993, the first comprehensive listing of member products which was intended to help GPs make recommendations to their patients. 

The data from the Everyday Healthcare Study was so valuable that it was decided to repeat it in 1997.  Then, in 2007 and in 2009,  more groundbreaking research was commissioned: Making the Case for the Self Care of Minor Ailments.

This was both quantitative and qualitative research and was a turning point for PAGB’s self care programme because the quantitative conducted by IMS Health, highlighted the cost of minor ailments to the NHS, (which was £2bn). Findings revealed there were 57m GP consultations involving minor ailments, taking up an hour a day of each GP’s time.  These findings generated huge interest particularly at a time when the CE of the NHS, David Nicholson was looking for efficiency savings of £22bn. 

Other findings from the research showed that supporting people to self care for common conditions could deliver on efficiency savings as well as actual savings through prescriptions costs (91% of all consultations ended with a prescription).

These figures were widely used in publications by a wide range of external organisations including NHS England, the Local Government Association, Pharmaceutical Services Negotiating Committee (PSNC), British Medical Association (BMA) and Royal College of General Practitioners (RCGP).  In addition, numerous surgeries and clinical commissioning groups have used the figures on their websites and they even show up on Wikipedia.  It was also published in the peer reviewed Self Care Journal.

The 2009 qualitative research was undertaken by Kantar TNS.  Through a series of interviews with pharmacists, nurses, doctors and consumers, the research provided a self care narrative which revealed some of the barriers to self care.  The most significant was that people with minor conditions went to the GP for reassurance that their symptoms were not serious.  If the doctor ended the consultation with a prescription this reinforced the patient’s belief and so helped to perpetuate that habitual behaviour.

In 2014, PAGB sought to repeat the IMS Health study and, in addition, find out how many A&E visits were for minor conditions.  Unfortunately it was not possible to repeat the quantitative research because the way surgeries collected data had changed.  However, research into A&E visits found there was a staggering 3.7m A&E visits for minor conditions which resulted in an annual cost of £290 million to the NHS. 

 

In 2016 further consumer research was commissioned and used to produce PAGB’s State of the Nation Report.  This research created a snapshot of the nation’s health and supported PAGBs call for a National Self Care Strategy.

PAGB will continue to undertake research to understand people’s self care behaviour and to ensure our messages are supported by a strong evidence base.

Self Care Research Projects

As well as commissioning research, PAGB has also spearheaded several self care projects. 

In 2000, as part of a new Health Action Zone project in Tyne and Wear, PAGB piloted one of the very first minor ailment schemes which served to encourage better use of the pharmacy for minor conditions. The pilot was a great success and in the years that followed, minor ailment schemes were extensively rolled out.  However, PAGB quickly realised that rather than empowering people, these schemes simply transferred dependency from the GP to the pharmacist.

Another project, with the Royal College of General Practitioners, aimed to increase the number of peer reviewed self care academic papers and inspired the international peer review Self Care Journal.   Another project, in conjunction with the Men’s Health Forum and the University of Bristol, sought to increase men’s use of the pharmacy.

In 2006 PAGB was given £300,000 by the DH’s Modernisation Action Fund for Joining Up Self Care in the NHS (JUSC) – a project undertaken in conjunction with Erewash Primary Care Trust (PCT) which aimed to evaluate the impact of a behaviour change approach.  Various interventions were used including a public campaign, self care leaflets, education sessions and promotions to support pharmacy advice.  The intention was for PCTs to embed the approach locally. Unfortunately, a major NHS restructuring took place just after the project, halving the numbers of PCTs which made it much harder to implement the approach.

JUSC was ahead of its time.  Similar types of joined-up initiatives have since been implemented across the country, particularly as part of Self Care Week.   This has seen clinical commissioning groups (CCGs) doing exactly what PAGB set out to do years earlier with JUSC, bringing together all the local health players including the local authority, pharmacies, surgeries, schools etc to help empower the local population.

Self Care Events and Collaborations

The first self care event to try to evaluate the adequacy of self care and make recommendations for improvements was held in June 1972 at the inaugural meeting of the Panel on Self Care.  Organised by PAGB, it took place at the Royal Society of Medicine and was attended by medical consultants, GPs and sociologists.

It was this event that kick-started PAGB’s work in engaging and collaborating with a range of stakeholders to effect behavioural change.  Since that very first meeting in 1972, PAGB has held numerous events to raise awareness and gather support and supporters for our self care ideas. PAGB has organised twenty annual self care conferences, most were endorsed by Government Ministers.  As part of PAGB’s secretariat role for the All Party Parliamentary Group on Primary Care and Public Health from 2004 to 2017, PAGB has also managed 13 inquiries into a range of areas of self care, and held more than 20 self care parliamentary receptions.

PAGB continues to hold self care events to raise self care issues and highlight our recommendations.  

The Self Care Forum: Change on the horizon

The research PAGB commissioned in 2009 was crucial in helping to pave the way to a new and exciting focus for self care and  was central to PAGB’s Self Care Campaign.  Written in the form of a manifesto to coincide with the general election, the Self Care Campaign, an “ethical imperative,” gained wide publicity when it launched in 2010.  It helped that it was signed by individuals from 17 key primary care organisations including the Royal College of Nursing (RCN), RCGP, the BMA and the NHS advocating for behaviour change.   

It was around this time that the dialogue was starting to change, with the idea of self care now embedded in policy, PAGB no longer had to make the case for self care  – it had been made loud and clear over the years and the message was understood.  Now it was all about implementation.  How could PAGB move from the “why” self care is important to the “how” it could happen.   This is where the Self Care Forum came in.

In 2011, spurred on by the success of the Self Care Campaign and led by PAGB and the Department of Health (DH), those involved in the Campaign were joined by 12 additional people to establish the Self Care Forum.  PAGB’s efforts through the years in stakeholder building had paid off when thirty people from various health bodies and professions, all passionate about progressing self care gathered in a room at Richmond House, DH in May 2011 for the inaugural meeting.  The Rt Hon Paul Burstow, who was a Health Minister at the time, was in attendance.  The Self Care Forum’s aim was to further the reach of self care, embedding it into everybody’s everyday life and making it a lifelong habit and culture. 

At the inaugural meeting, the Self Care Forum was asked to take over the running of Self Care Week.  This week long annual event has gone from strength to strength, in its first year as organisers there were less than 50 participants; in 2018 more than 600 organisations participated which reached more than half the population in England! The Week has grabbed the attention of influencers overseas and in 2018, the European Union helped to fund Self Care in Europe which held its first Self Care Week in Europe campaign, something that will be repeated in 2019.

2020 will mark the dawn of a new Self Care Forum as it establishes a new relationship with PAGB which has been its benefactor since 2011.  The Self Care Forum continues to be the only national organisation in the self care space that supports the practice of self-medication as part of its wider ethos.

Self Care in Heath Policy 

PAGB has always realised the importance of influencing Government to effect policy change, and when it comes to self care, this is just as critical.  The work PAGB and its partners have done over the years has ensured that the ideas of self care as an integral part of health care are firmly embedded in Government health policy documents. 

Indeed, after decades of lobbying, meetings, events, consultations and briefings there is now a plethora of health policy highlighting the importance of self care; dating back to 1979, when it appeared in the Royal Commission Report which considered the “best use and management of the financial and manpower resources of the NHS”.

Intelligent self-medication and care can undoubtedly reduce demands on healthcare services and it is essential that society accepts the need for appropriate self care”

Royal Commission Report on the NHS, 1979 (5.19)

In the late 1990s PAGB worked closely with the Patient Empowerment Team at the Department of Health to ensure self care was included in the seminal 2000 NHS Plan.  The Plan recognised self care as the “front line to health care in the home”, noting that “most healthcare starts with people looking after themselves and their families in the home.”

Speaking at PAGB’s 2002 Annual Conference, Hazel Blears, Junior Health Minister said 

One of the key pillars of the NHS Plan is self care….Supporting self care is not about saving money. It is about spending resources effectively on activities that help people look after themselves and their families better in the way they would like.”

The tipping point for self care came when the sheer weight of health policy documents (at least thirty) enshrined self care as a core principle in health care. But the journey is far from over. 

Defining Self Care

In 2005, confusion over what is self care and what is self management of long term conditions had PAGB leading a meeting with the Department of Health and stakeholders from the health profession to agree its official definition of self care.  The definition wasn’t exactly succinct:

Self care is the actions people take for themselves, their children and their families to stay fit and maintain good physical and mental health; meet social and physcological needs; prevent illness or accidents; care for minor ailments and long-term conditions; and maintain health and wellbeing after an acute illness or discharge from hospital.”

This definition was used by Gopa Mitra and Dr Pete Smith (Hon President of the Self Care Forum) to design the self care continuum, a diagram that is widely used to illustrate the meaning of self care and something that PAGB updated recently in its Self Care White Paper: supporting the delivery of the NHS Long Term Plan.

A sign that self care had made inroads was in 2016 when it entered the Oxford Living Dictionary (which has since become Lexico) becoming a word used widely and not confined to the consumer health care industry and the NHS.

Self Care Continuum
TYB Logo

Campaigning and Promoting

To help promote self care, PAGB has on occasion, engaged in public facing activity. In 1997 it set up the Consumer Health Information Centre (CHIC) with a steering group of doctors, nurses and patient representatives.  Over several years, PAGB, through CHIC, launched a series of consumer campaigns promoting self care.  It even joined forces with the British Medical Association’s Doctor Patient Partnership and the Men’s Health Forum to promote joint campaigns.

In 2013 PAGB launched Treat Yourself Better (TYB), a public campaign to promote the message that antibiotics would not treat colds or flu and that the pharmacy should be the first port of call for minor conditions.  It was a great success and caught the attention of the Chief Pharmaceutical Officer at NHS England who met with PAGB.  TYB was the inspiration behind NHS England’s “Stay Well this Winter” campaign, which became “Help Us Help You”, run by NHS England, NHS improvement and Public Health England.  PAGB member companies are encouraged to use the Help Us Help You logo on relevant products.  

Conclusion

Spanning five decades, PAGB’s self care work programme has been rich and complex proving that to effect behaviour change there is no silver bullet.  It is a long-term goal and cannot happen without a number of levers and commitment from a variety of players.  Whilst there is still work to do, we can still be proud of the progress that PAGB has made over the years.  PAGB’s relentless efforts mean that self care is now enshrined in health policy.  It is widely acknowledged that self care benefits people, the NHS and society and we have quite clearly made the case for self care.   

PAGB can also take credit for helping to make the phrase “self care” part of common parlance.  Until recent years it was only used by industry and the NHS.  Indeed, the practice of self care is much broader than what PAGB originally envisaged and people now talk about self care in terms of wellness.  It is firmly in people’s psyche and has become cultural in the “wellness” sense.  The next step for PAGB and the Self Care Forum is to push on as we strive to help increase people’s ability to self care for their self-treatable conditions.

The tipping point is ever closer.

By Libby Whittaker, PAGB

 

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